Individual provider Active NPI

Katrina Karis Wu, CNM

  • Advanced Practice Midwife
  • Minneapolis, MN
National Provider Identifier
1194063214
Registry record updated Nov 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
R 217817-6 Issued in MN
Practice address
3033 Excelsior Blvd Ste 585
Minneapolis, MN 55416-6400
Phone
(612) 345-5920
NPI assigned
Jan 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X AP60332347 WA
Advanced Practice Midwife 367A00000X R 217817-6 MN Primary

Addresses

Primary practice location

3033 Excelsior Blvd Ste 585
Minneapolis, MN 55416-6400

Mailing address

2 Pine Tree Dr
Saint Paul, MN 55112-3754
Phone (503) 334-9881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
R 217817-6MNMDAdvanced Practice Midwife
AP60332347WAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Amy E Johnson-Grass Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699660800000",
    "number": "1194063214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PINE TREE DR",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551123754",
            "telephone_number": "503-334-9881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 EXCELSIOR BLVD STE 585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554166400",
            "telephone_number": "612-345-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WU",
        "first_name": "KATRINA",
        "middle_name": "KARIS",
        "name_prefix": "Dr.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2023-11-11",
        "certification_date": "2023-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WA",
            "license": "AP60332347",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MN",
            "license": "R 217817-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.